Orthotics, commonly prescribed to minimize abnormal movements, such as frontal plane movements, of the foot during running, are supposed to reduce the likelihood of lower leg injury.
Excessive frontal plane movements of the foot during midstance in running is linked to tibial stress fractures.
- Creaby and Dixon reported that frontal plane force vectors induced bending loads on the tibia, causing the bone to eventually crack when tibial loads exceed the capacity for bone remodelling.
What Causes Abnormal Foot Movements During Running?
In three landmark studies, Robbins et al. found that frontal plane movements grew abundantly when more cushioning was placed under the foot. The researchers posit that thick cushioned soft running shoes are solidly linked to producing high-amplitude frontal plane movements of the foot due to material compression.
It then follows that dialing down the amount of shoe cushioning reduces frontal plane movements of the foot, demonstrating that this approach is far better than orthotic intervention. Why? Because the problem isn’t you, it’s the shoe.
Do Orthotics Even Work?
Orthotics are the subject of popular misconceptions: arch height variation, muscle strength imbalances, flexibility problems, running experience, past injury, etc. causes abnormal movements of the foot. So, do orthotics help? Not really.
The only cure for the seemingly uncontrollable movements of the foot is by running barefoot or in pure minimalist shoes. Supporting this, a study by Ekenmen et al. found that orthotics had only minor success at reducing tibial strain.
A more current study by Boldt et al. found that the application of medially wedged orthotics to cushioned running shoes had minimal effect on knee and hip joint kinematics in the prevention of knee pain.
Other researchers admit that gait retraining is probably more effective than orthotics at reducing loads on the lower leg during running. Another obstacle is that podiatrists need to decipher how custom orthotics and cushioned materials of a shoe fit together.
What is irrefutable, however, is that shoe cushioning plays an active role in causing many injuries related to abnormal foot movements in runners. Often, in cushioned running shoes, frontal plane movements of the foot is preceded by a rapid spike in impact at touchdown due to a powerful desire of the foot to plant itself firmly on the ground.
Suppression of unwanted foot movements during running begins with wearing less on your feet, better yet, go barefoot as it forces you to learn movement/impulse-control skills that few habitual shod runners acquire. This claim is not anecdotal, but supported by decade’s worth of research.
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Boldt et al. Effects of medially wedged foot orthoses on knee and hip joint running mechanics in females with and without patellofemoral pain syndrome. J Appl Biomech, 2013; 29(1):68-77.
Creaby MW and Dixon SJ. External frontal plane loads may be associated with tibial stress fracture. Med Sci Sports Exerc, 2008; DOI: 10.1249/MSS.0b013e31817571ae.
Ekenman I, Milgrom C, Finestone A, et al. The role of biomechanical shoe orthoses in tibial stress fracture prevention. Am J Sports Med. 2002;30(6):866–70.
Mundermann A, Nigg BM, Humble RN, et al. Foot orthotics affect lower extremity kinematics and kinetics during running. Clin Biomech. 2003;18(3):254–62.
Robbins, S. and Waked, E. G., Athletic footwear affects balance in men, Br.J. Sp. Med., 28, 117-122.1994.
Robbin S and Waked EG. Foot position awareness:the effect of footwear on instability, excessive impact, and ankle spraining. Clin Reviews in Phys Rehabil Med, 1997;9(1):53-74.
Robbins, S. E., Waked, E. G., and McClaran, J.Proprioception and stability: foot position awareness as a function of age and footwear, Age Ageing; .24, 67-72, 1995.
Robbins, S. E., Waked, E. G., Allard, P., McClaran, J., and Krouglicof, N., Aging in relation to optimization of footwear in older men, J. Am. Ger. Soc., 45, 61–67, 1997.
BSc Neurobiology; MSc Biomechanics candidate, ultra minimalist runner & founder of RunForefoot. I was a heel striker, always injured. I was inspired by the great Tirunesh Dibaba to try forefoot running. Now, I'm injury free. This is why I launched Run Forefoot, to advocate the health & performance benefits of forefoot running and to raise awareness on the dangers of heel striking, because the world needs to know.
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